BACTERIAL OVERGROWTH SYNDROME OF GASTROINTESTINAL TRACT I N ACUTE NECROTIZING PANCREATITIS

Abstract

Summary. Purpose: to study the changes in the microflora of the upper parts of digestive tract during acute necrotizing pancreatitis. Material and methods: acute necrotizing pancreatitis was induced in 42 white rats, changes in the mucous microflora of the upper part digestive tract have been dtudied. Bacteriological examination of the contents of the proximal small intestine was performed in 42 patients with acute necrotic pancreatitis during gastrofibroscopy. Results and discussion: Induction of acute necrotic pancreatitis was accompanied by impaired colonization resistance of the intestinal mucosa due to the elimination of bifidobacteria and lactobacilli: the frequency of their growth from the mucosa decreased threefold (p<0.01), and the population level, respectively, by 25% (p<0.05) and by 36% (p<0.02). The mucosa was actively colonized by gram-negative pathogenic and conditionally pathogenic enterobacteria on a high population level (3.07-5.39 lg CFU/g), which allowed this microflora to overcome the damaged intestinal barrier and translocate. Pathogenic Escherichia spp and Proteus spp were cultivated from the mesenteric lymph nodes 24 hours, Enterobacteria spp and Staphylococci spp were isolated from portal blood, pancreatic tissue, and peritoneal cavity 48 hours after induction of acute pancreatitis. Eight strains of gram-negative microorganisms were isolated from the small intestine and identified in 69% of patients before surgical interventions. Same microflora was cultivated from pathological foci in 57.4% of patients during the postoperative period. Conclusions: During acute necrotizing pancreatitis severe deficiency of autochthonous anaerobic microflora occurred in the upper parts of the digestive tract, which caused excessive colonization by pathogenic and conditionally pathogenic microorganisms and promotes bacterial translocation.